Anaemia and nutritional status of adolescent girls in Babile District, Eastern Ethiopia

Introduction Nutritional status during adolescence plays an important role in the human lifecycle that influences growth and development and during this period nutrient needs are the greatest. The objective of this study is to assess anaemia and nutritional status of adolescent girls in the Babile district, Eastern Ethiopia. Methods Data were collected from 547 adolescent aged 10-19 years by cross sectional study design. WHO Anthro-plus software was used to analyse Nutritional statuses of adolescents and magnitudes were determined using WHO 2007 references point. Haemoglobin was measured on site by hem cue machine. Descriptive and inferential statistical analysis was carried out depending on the nature of variables. Results The result of the study show that 21.6% thin, 4.8% were over weighted and 1.1% was obese, 32% were anaemic and 15% of adolescents were stunted/ short stature than normal. Nutritional status of adolescent were low both in urban and rural adolescents, but severe thinness were higher among of rural (39.3%) compared to urban (37.5%) adolescents. Factors independently associated with stunting were place of residence, father occupation source of drinking water and age of the adolescents. Conclusion Nutritional status of adolescent girls contributes to the nutritional status of the community. There is a need to initiate intervention measures to improve the nutritional status of adolescent girls who are the future ‘mothers-to-be’. Hence, there is a need to create awareness among adolescents and their family about nutrition and health.


Introduction
World Health Organization (1986) defines adolescents as persons aged 10-19 years. This age group make up roughly 20% of the total world population and this period is transition from dependent childhood to independent adulthood. Physical growth at adolescent occurs earlier and is more rapid than during pre-adolescence [1].
Twenty percent of the final adult height and 50% of adult weight occurs during this period: bone mass increase by 45%, dramatic bone remodelling and soft tissues, organs, red blood mass increase in size [2].
The world health organizations, declared that, adolescent remain largely neglected, difficult to measure, hard to reach population in which the need of adolescent girls in particular often ignored [3].
Nutritional status during adolescence plays an important role in the human life cycle [4]. The diet of children and adolescent must be adequate to support normal and sometimes very rapid growth and development [5]. Nutrition in general influences the growth and development throughout infancy, childhood and adolescence; it is, however, during the period of adolescence that nutrient needs are the greatest [6]. Remarkably, 84% of the adolescents are in developing countries [3,7]. Adolescent constitutes about 48% of Ethiopian population and about 25 percent of this age group is girls [8].
Among adolescents, girls constitute a vulnerable group, particularly in developing countries where they are traditionally married at an early age and exposed to a greater risk of reproductive morbidity and mortality [9]. The health and nutritional status of the adolescents' girls are the reflection of cumulative effect of physical growth, the onset of the menarche and an increase in fat and muscle mass which place extra nutrition requirement. Physical growth of the adolescent girls' generally related to their dietary intake which is determined by the availability of food in terms of quantity, quality and the ability to digest and absorb and utilize the food. Furthermore, under-fed girls are at risk of being stunted mothers who are likely to suffer obstetric complications and to deliver low birth weight babies [10]. In the absence of effective nutritional interventions, the low birth weight girls become the next generation of stunted mothers, thus, perpetuating the vicious cycle of malnutrition. Finding from Guatemala study on maternal-childpair revealed that maternal birth size was a significant predictor of child's birth size and Child's birth weight increased by 29 g/100 g increase in maternal birth weight and child's birth length increased by 0.2 cm for every 1 cm increase in mother's birth length [11].
Studies from Asia [12][13][14][15][16][17] and few studies from African countries [18] have reported variances in prevalence of under nutrition that all of them signify adolescent malnutrition is a prevalent problem among the study population. Few studies in Ethiopia found that, under nutrition was common problem among adolescent girls, [19][20][21]. So, the current study aims at assessing magnitude of anaemia and nutritional status of adolescent girls in Babile district in Eastern Ethiopia.

Sampling technique
Out of 21 kebele, the study was conducted among one urban and ten kebele from rural kebele were included in the study. By considering the list of the households as sampling frame and taking the adolescent in the households as sampling unit, simple random sampling was employed in order to select the households.
Proportionality of the number of adolescent in each kebeles was also assumed. If adolescent girl/s is/are not found in the house, proximal household was included. In cases where there are two or more adolescents in the same households, one of them was selected randomly by lottery method. Adolescents in the age 10-19 years with severe illness and who are unable to speak were excluded from the study. Data were collected by laboratory and nurse diploma professionals after training was given. The data collectors were trained intensively on the data collection procedures, the context of specific questions across the questionnaire, anthropometric measurement procedures.
For Haemoglobin determination two laboratory technicians to were employed to collect and process the sample of blood.
To control quality of data questionnaire was prepared first in English then translated Afan Oromo language then back to English to maintain its consistency. Four day training was given for the data collectors and supervisor about the objectives, methodology and process of the data collection by the principal investigator. The questionnaires were pre-tested among 5% of the total sample size in Haramaya district (out of study site). Based on the pre-test, validity and reliability of the measurement was checked, questions that pose difficulty were revised, edited, and those found to be unclear or confusing was removed. Each data collector obtained an opportunity to be acquainted with the interview and measuring technique. Two different measurements were taken for the height, weight and MUAC by two different measurement takers for every study subjects so that the average of the two were considered for the analysis. This would help in reducing the occurrence of measurement errors by single individual measurement. The principal investigator and supervisors were compiling the completed questionnaire every day and check them for inconsistencies, incompleteness and omissions. Any filled questionnaire which has a defect was rejected from the study. Moreover, data were double entered to check for data entry errors and correctness. The principal investigator was responsible for co-ordination and supervision of the overall data collection process.
The data were entered to Data EPI data and cleaning and editing was under taken before analysis. For the analysis SPSS (v 16.0) statistical packages was used for the analysis of the study.
Descriptive statistics: Frequency, mean, standard deviation, and correlation was computed for the interest variables. Normality was checked by different plots (P-P and/or Q-Q-plot) if normality will not be maintained (food, meal frequency, anthropometric and biochemical analysis), in place of mean median was considered.
Anthropometric data were entered and analysed using WHO Anthroplus software. Bivariate and multivariate binary logistic regression regressions were applied when the variables are normally distributed. P-values of 0.05 were used as cutting points to determine significance of the variables Ethical clearance was obtained from Haramaya University Institutional Research Ethics Review Committee. The data collectors were explained the objectives and benefits of the study to get informed oral consent from the study subject's family prior to data collection. When the study subject less than 18 years, we got informed oral consent from the study subject's family prior to data collection and additional verbal incent is obtained from the study subject when the study subject is less than 18. The respondents was told as they have the right to refuse or decline from the study at any time and refusing to participate on the study couldn't bring any effect on them.

Results
In this study, out of 600 samples selected, a total of 547(91%)  (Table 1).

Prevalence of anaemia and under nutrition among adolescent girls
Among 547 adolescent involved in the study 32% were anaemic.
Adolescent girls between the age 17 and 19 years were more thin (29.5%) , followed by age 16 years. Similarly stunting was higher among age 17-19 ages group and lowest were recorded among age 15. In the present study, level of anaemia were higher among age 16 years and followed by age 17-19 (Table 3).

Factors associated with nutritional status
In a bivariate logistic regression model variables with significant associations were identified. Finally those variables which have association in bivariate models were taken to multivariate logistic regression to compare the independent associations for solving cofounding effects of the variables. In multivariate logistic regression; place of residence, father occupation, thin, age of adolescent and source of drinking water were significantly associated with stunting. This study showed adolescent living urban were 57% less likely stunted compared to adolescent livening in rural (AOR=0.428, p=0.006) adolescent from farmer father were more 2.4 times more likely stunted compared to adolescents whose fathers were not farmer (AOR= 2.4 95%CI= 1.2-4.8) adolescent aged 10-14 were 48% less likely prone to stunting than aged 15-19(AOR= 0.52 95%CI= 0.30-0.90). Similarly this study revealed that those thin adolescents are more likely stunted compared to their counterparts (AOR= 3.5 95%CI= 2.1-6.1) ( Table 4).

Discussion
A strength of this study was it is community based study and the random selection of the households. Generalization may be made to the study communities as an attempt was made to identify randomized households and adolescents from the study communities. The major limitation of this study was the failure to collect information related to pubertal landmarks. Another limitation of the study was that the cross-sectional design makes any inference of growth pattern over time difficult. The cross-sectional nature of the study could only generate a hypothesis about the possible role of certain independent variables on the nutritional status of these adolescent girls but not their causal relationships.
This study have been documented that anaemia and nutritional states of Adolescents is an important concern for public health in Ethiopia. Adolescent is a transitional period between childhood and adulthood, targeting adolescence can provide an opportunity to prevent the onset of nutrition related chronic diseases in adults life, addressing adolescence specific nutrition issues and possibly also correcting some nutritional problems originating in the past.
This study revealed that nearly one third (32%), of adolescents were anaemic. Of which 1.8% had severe anaemia. Prevalence of stunting in these adolescent girls was 15.0%. This poor nutritional status of the girls remains uninterrupted throughout their adolescent life as stunting, is considered as index of chronic or long term duration of under nutrition, was observed during the entire period of adolescence. The study girls were considerably shorter than the reference population suggesting that they had not fully recuperated from childhood deficits. This figure is lower than study conducted in rural Tigray [19].

Conclusion
The result of the study revealed that prevalence of anaemia,

Competing interests
Authors declare no competing of interest.

Authors' contributions
KT designed the study, coordinated data collection, performed analysis and interpretation of data and drafted the manuscript. YD

Acknowledgments
Authors are thankful to adolescent girls and their families for their cooperation. We are especially grateful for Haramaya University for the assistance and financing to carry out the present work. Tables   Table 1: Descriptions of the respondent's socio-demographic condition of adolescent girl in Babile district of eastern Ethiopia,